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Promoting a culture of mediation: a challenge for the health system

On 15 April, we organized a seminar with the title "An ethical perspective on conflict management", in partnership with the Catalan Society for Mediation in Health. The purpose of the meeting was to provide a platform for expert discussion of how those in care settings address the management of conflicts, whether between medical staff and patients as a result of lack of information or medical errors, or within care teams and within health organizations more generally.

Participants agreed on the need to promote a culture of mediation between professionals, patients and institutions, as an instrument that would provide an alternative to resolving conflicts in the courts. Experts believe that there is a lack of a real culture of conflict prevention in care settings, and that organizations need to consider how to deal with conflict, and to adopt organizational measures to implement conflict-resolution instruments.

According to Francesc José Maria, honorary president of the SCMC, "to implement a culture of mediation, we need an overall framework to ensure that resolution is not improvised case by case". To make progress, "management teams must be convinced of the need, both professionals and patients must be aware of the options, and values of negotiation and dialogue must be transmitted". Health institutions should review their procedures and protocols (on harassment and abuse), and there needs to be debate within the organization, accompanied by review of codes of ethics. Experts also argued for the need for health authorities to introduce a quality standard to accredit health centres and their use of mediation to resolve conflicts. According to José Maria, "the ethical credibility of health organizations may be called into question if they do not take action to prevent conflict or if they fail to respond rapidly and decisively when conflict does arise."

Begoña Román, president of the Social Services Ethics Committee, believes that mediation must be rooted in ethics. She stressed the values of mediation, "seeking to ensure that everyone is a winner, empowering the parties, and enabling them to be the ones who establish when enough has been done and how far to go". For Román, "conflict is inevitable and is a symptom of freedom and pluralism; it needs to be managed, not hidden."

Màrius Morlans, vice president of the Ethics Committee of Catalonia, argued that, "mediation has to be based on dialogue, active listening, empathy, reasoned argument, self-criticism and emotional restraint". And Francesc Borrell, a family doctor, offered the perspective of a health professional who has direct contact with patients. In Borrell's view, "conflict often arises when courtesy is lost". He argues for the need to promote communication, information and transparency as key elements to prevent conflict. Montse Busquets, of the School of Nursing, offered the perspective of patients. She argued that, "patients are vulnerable and mediation must become an instrument to help them explain their feelings of anger, but also to identify the emotions behind their reasoning".

Finally, participants agreed on the need to stimulate further debate, and to invest resources in training health professionals in the skills they need to engage in conflict resolution.

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Course at COMB (College of Doctors of Barcelona): Caring for the chronically ill (act)

This intensive course is designed to give doctors and health professionals more direct knowledge about the situation with regard to chronic illness in Catalonia, and about the programmes that have been implemented in response, and also addresses the question of ethical challenges and the tools that exist to cope with these.

Learn how to manage resources effectively without neglecting the needs of the person, placing the individual at the centre of your decision-making and accompanying them throughout the process, two essential elements of appropriate Course: Caring for the chronically ill care for the chronically ill.

The course will provide professionals with the tools they need to meet these challenges, with a twin focus on theoretical and practical knowledge.

Institut de Formació Mèdica i Lideratge del COMB. Access from carrer de Vilana (at the corner with carrer de Dalmases) Floor -1

'Nuevas políticas del cuidar'

Marian Barnes, sociologist and social policy expert, approaches the ethics of care from a perspective that transcends illness and economic hegemony. This publication includes two lectures give at the seminar on Ethics and the values of care, organized by the Official College of Nurses of Barcelona, in partnership with the Víctor Grífols i Lucas Foundation.